Falling Back Into The Groove

falling back into the groove (for lack of a quirkier title)...

speechlovetx.blogspot.com

Whew. It's really been a minute since I've taken the time to blog, but something about having the house to myself, four cuddly cats, and a vanilla sweet cream cold brew from Starbucks is making me want to write. So here we are. Hi everyone out there! I started this blog in the Spring of 2014 when I was a single, newly- licensed SLP driving an hour + back and forth each day as part of my home-health gig, and here in 2016 I am a married cat mama of four ridiculous little ones (see picture below) still working in home-health (with a company I love) and driving a whole lot less, thankfully. I'm now supervising and while that has been an adjustment it has been a welcome challenge. If I decide to continually update this blog, it may be gradually punctuated by more personal posts or I may start a completely new blog for that purpose all together.

when you try to take a family photo
but the kids start fighting on your lap.

So September. I always get so excited when Fall hits because ironically I have more Halloween therapy materials than for any other season. It's just such a language-rich time and there are so many verbs to describe the season with- scare! rake! jump!. I love it. I have to say though, I do want to take advantage of this time before Halloween truly hits and just enjoy the transition. We miss it so many times, in our excitement for October when the chilly air finally hits in Texas and it truly feels like Fall. This morning I blasted myself with cold AC in the car just to simulate the experience. And it worked. lol But I really think there is beauty in this in-between time when there's some warmth to the air but you're just getting a glimpse of changing colors and it's almost in your grasp. Gah.

So this month I will be trying to find some early Fall activities that are more "school-starting" and less Halloween-y for the time being. If you missed it, I have an awesome "Fall Choice Trees" product which is essentially a First-Then board that looks like a tree with the choices being leaves, and contains both English and Spanish versions. Check it out if you care to.

What I'm loving this month so far...

Drink: Vanilla Sweet Cream Cold Brew. Duh.
Therapy Toy: I'm really digging books, ya'll. I know, groundbreaking. But I love seeing how the kid attempts to "read" me the story before implement some verbal scripts and then after a week the language that they use to describe the pictures. I like to tell parents to read their children books using the same language each time and then turn the book around and say, "Now you tell me the story," giving hints with small words such as, "And then..."
Therapy App: Oh boy. I haven't bought many apps lately. I use Articulation Station a ton though and the My PlayHome app for language scripting and everything in between.
Therapy Activity: I enjoy using this backpack coloring page for a cut-and-paste this time of year using artic pictures:

Get it here!

And that's all I've got for now. Besides a couple of evals I might be putting off by writing this post...:)

Until next time,
LL

I'm in a love/hate relationship.

I'm torn, Medicaid.

I love you, but I hate you.

I love your reimbursement rates, but I hate the way you don't listen to anything I say.

Doesn't matter how good my narrative is, you'll glide right over all that functional implication talk and zero in on my standard scores.

I mean, aren't I more than a number to you?

All I want is a little validation here.

The biggest complaint I have is your wishy-washy ways. You change the rules of our relationship faster than I can say compliance.

I guess the biggest elephant in the room would have to be a little something called...Home Exercise Program (HEP). You want me to implement one, document it constantly, and if I don't change things up frequently enough, you get bored with me and slap me on the wrist.

I need a solution. I'm not saying we need to break up...I just need to simplify the process so I can find "me" again.

That being said, here's my new plan:

This 11-page .pdf includes parent/caregiver hand-outs for seven common goal areas for preschool and early receptive/expressive language skills.

I also created a HEP Data Log that can be filled out by you and the caregiver on a session-by-session basis to track weekly HEP implementation. 

These hand-outs include practical suggestions for functional, in-home HEP activities for the following goals:

- Requesting
- Body Parts
- Clothing 
- Early Prepositions (in/out, on/off)
- Advanced Prepositions (under, behind, in front of, next to)
- Vocabulary (Nouns)
- Descriptors (Adjectives) 

All you have to do is make a copy of the data log for each child, give the parent a corresponding hand-out, and circle an activity.

Voila- simplified HEP implementation.  Check it out HERE. 

Please let me know if you check out this hand-out packet or have any questions!:) 

Bunny Body Parts + A Sad Tail (I Mean Tale)

I'm going to start this post off with a sad tale.

When I was 11, I had a German lop-eared rabbit named Nibbles. She was my pet and parent's answer to me and my brother's severe fear of dogs following the trauma of a dog attack. I fed her spinach, chocolate rice-krispie treats, and included her in family home videos over the course of a year together. 

We were a good fit.

One day, she got spooked by a cat outside and attempted to make a break for it through the closed door of her wire hatch, which didn't go so well. Nibbles paralyzed herself from the neck down and spent the remainder of her days watching me from pillow where she could only wiggle her little brown nose and gaze up at me adoringly.

Nibbles had a short life but a good one, despite a freakish and unfortunate demise. 

Moral of the story: you can't rehabilitate a paralyzed rabbit. Also, rabbits are good companions and fun for children.

They're cute, they're cuddly, and they're also an endless source of inspiration for April-themed speech and language activities. 

That being said, this morning I decided to get creative and put together a new printable activity called "Bunny Body Parts"! You can find in my Teachers Pay Teachers store here.

I chose to use this today to put together puppets with my kids to target some of the following goals:

Age 2-3:

- Receptive/expressive body parts

- Imitation of gross actions (pointing to body parts in imitation, placing corresponding picture to body part on self, actions such as "hopping")

- Requesting 

- Imitation of single syllables/words

- Spring vocabulary

Age 4-5:

- Articulation: /f/ in initial position of words ("Do his eyes go on his /f/ace or body?"); drill to receive each body part; received an "egg" for the bunny for each page of drill completed

- Possessives: "Who's eyes are these? His eyes." 

- Expanded sentence structure: "I want to glue the __________."

- Verbs/actions

- Pronouns: pick a verb card: "I jump. Do you jump? Do bunnies jump? They jump." 

Here is the final product also seen with some Spanish verb cards I used to target expanded sentences and actions. The kids thought it was hilarious to imagine bunnies doing some of the things we identified only people do, such as driving. 

I also brought along Play-Doh and Spring-time cookie cutters for a corresponding sensory/language activity. 

This download comes with all the pieces you need to make a puppet along with three bonus Easter eggs and a carrot for further reinforcement or activities.

You could also make each piece into a magnet and make a fun cookie sheet activity, too.

A couple things I should have done in advance to prep this activity:

a) Cut out all the pieces in advance and put them in baggies (unless your kids are older and can help, there are several body parts and the process is too time-consuming), and

b) Limit the number of body parts for little ones (i.e., only necessary parts such as the nose, eyes, etc.) 

Over all, these puppets got big "wow's" from all my kiddos. I used .39 cent white bags from Michael's which paired with the light/pastel coloring in the document made the activity very-cost effective.

Feel free to check out "Bunny Body Parts" and leave me any feedback if you decide to use it! 

Also, do you have any sad or strange Easter pet stories?

Home-Health vs. Private Therapy Settings: A Review

Good morning everyone!

I am back with a monstrous headache today, that as the SLP part of my brain identified, is running from my frontal lobe all the way to my left temporal lobe. The weekend was just a little too crazy (in other words, non-routine) and I think my brain spent most of Monday trying to integrate everything and re-orient to the usual schedule. Man, change really screws me up. Sometimes I really identify with some of my kiddos in that way. :)

Anyways, as I have been fortunate to have been able to dip my toes into several SLP settings thus far, I wanted to give you all a short "review" of home health and compare it to a clinic or private setting if you are curious about switching to either.

First just let me say, I love home-health. But I truly believe (like any setting) that the company, district, or management makes all the difference. It is definitely possible I would not be quite as happy working for another home-health company. And as we all know, every setting has their horror stories. The company I work for, however, is extremely ethical, caring, and an advocate for their therapists on a professional and personal level. I have been with them since my first semester of grad school starting out as an SLPA, through my Clinical Fellowship, and now as a certified SLP. I am blessed to be a part of the work they are doing. We offer ST, OT and PT, but the majority of our therapists are SLPs and SLPAs.

Pros:
- You can set your own schedule.
Only want to work 4 days a week? Only want to work mornings from 8-1? You got it. Provided you stay within the guidelines set by insurance (some require 2 sessions per week from day Y to day Z, cough cough, TMHP) and work with parent schedules, you can make clients fit into your preferred work hours.

- You can work as little or as much as you want to.
This is ideal for therapists who have children or want to split home-health with another setting. You can take on a part-time or full-time caseload depending on your availability. Full-time caseload is currently around 15 kiddos in my world. You can also pick up evaluations for extra money in nearby locations for treating therapists who do not have time to evaluate for whatever reason.

- You can choose to accept or decline a client (within reason).
Even if you choose to evaluate a child, you may be able to decline accepting them onto your caseload if you feel your caseload is too heavy or time restraints currently make it difficult to fit them in.

- Sessions are typically shorter.
In my experience, I found that while all my home-health sessions lasted 30 minutes in length, often my private setting sessions lasted up to 45.

- Compensation rates may be higher, depending on the company.
This may be relative on a case-by-case basis, but I hear many home-health therapists agree with this statement.

- You can target goals in the child's natural setting.
To me, this is one of the biggest pros. I love being able to show a parent how to integrate HEP (Home Exercise Program) into activities using the child's own toys and environment.

- Scrubs.
One word: comfy.

- You can stop at Starbucks in the middle of the day.
Self-explanatory.


Cons:
- You're in the car. All. The. Time.
Sure, you get to have some great car dance sessions, and you better believe I've had the time of my life during the summers belting out some Blink-182 while sipping an Icee on the way to sessions. But believe me, it gets old, and when your friends/boyfriend/husband mentions driving somewhere after work, even if it's 20 minutes away, you'll feel like bursting into tears.

- Some companies may not reimburse you for gas or travel expenses.
My company does not. However, I do believe my session rate is higher to compensate for this. I also use my personal vehicle for visits which obviously puts me at a greater risk for traffic violations, accidents, etc.

- You may not have access to a wide-range of materials or more expensive programs such as Boardmaker, like you would in a clinic.
Seriously, I am dying to get my hands on a copy of Boardmaker.

- The rooms of your home and backseats/trunk of your car will be filled with toys.
As I tell my boyfriend, I am a traveling preschool. I miss having an adult bedroom.

- You are isolated from other therapists/adults.
One thing I definitely miss about the private/clinical setting is daily interaction with other therapists, including OTs and PTs. Home-health can be lonely and you will have to make the effort to stay in contact with friends and other therapists so you don't get too bummed out.

- Parents may take advantage of the fact you are coming to them instead of the other way around.
I have experienced more cancellations in home-health than in private settings, in general. Because my company works with Medicaid only, I believe some families take advantage of the "free" nature of the evaluations, sessions, etc. and will cancel moments before you arrive.

- Every home is different in terms of cleanliness and overall atmosphere.
I have been in homes where I have fought off roaches while reading a story as well as homes that are nicer than those in North Dallas. It really is hit or miss. You just have to be willing to deal.

- You may have to fight the urge to stop at Starbucks in the middle of the day.
You don't need a grande Java Chip frappucino with no whip and extra drizzle every day after that session with Little Johnny but by golly yes you DO.

So there you have it. For me, the pros definitely out weight the cons currently in home-health. I know at some point I will attempt the schools again (I only did my internship there in grad school) but for now I am happy right where I am.

What setting are ya'll a part of right now? I'd love to hear along with a pro/con or two:)